Unraveling the enigma: chronic kidney disease of unknown etiology and its causative factors with a specific focus on dissolved organic compounds in groundwater-reviews and future prospects.

Chronic kidney disease is globally recognized as a highly impactful non-communicable disease. The inability of early identification contributes to its high mortality rate and financial burden on affected individuals. Chronic kidney disease of uncertain etiology (CKDu) constitutes a significant global public health concern. This condition does not arise from traditional risk factors such as diabetes, hypertension, or glomerulonephritis. More than 150 articles were analysed to understand risk factors of CKDu. This study aimed to investigate the potential association between dissolved organic compounds, such as Polycyclic Aromatic Hydrocarbons and Humic Acid, and the incidence of CKDu. Through a comprehensive literature review, we identified CKDu clusters worldwide, including notable nephropathies, and explored their potential links with organic compounds. Our analysis revealed that organic compounds can leach from sediments and low-rank lignite deposits into groundwater, subsequently contaminating water supplies and food. These compounds have been implicated in the development of diabetes and increased heavy metal mobility, both of which are risk factors for kidney disease. Our findings suggest that exposure to organic compounds may contribute to the etiology of CKDu, underscoring the need for regular monitoring and establishment of baseline and threshold values in water and soil. We also emphasize the importance of analyzing organic compounds in groundwater in CKDu hotspots and establishing distinct registries for CKD and CKDu implementation.